Wednesday, February 26, 2014

How to Avoid the Two Words That Cost Thousands in Medicare Bills: "Under Observation"

It’s not something they teach doctors in medical school. And it’s probably not something you’d know to look for if you were suddenly rushed to the hospital in an emergency. But when a doctor decides to write the words “under observation” on a Medicare patient’s chart, it can have lasting consequences.
Those two little words can be the difference between spending thousands of dollars out of your own pocket and having Medicare cover the entire bill.











Brenda Kelley-Nelum was driving her husband Al 'Doc' Nelum to an appointment when he started having symptoms of a stroke.   An ambulance took him to the nearest hospital with a stroke clinic. Hours later they were still there, waiting on test results, when someone mentioned her husband had been put on observation status.  As an advocate for seniors in Virginia, Kelley-Nelum had a vague recollection that she’d heard that term before. And it wasn't good. 
She was right to worry.
As it turned out, her husband would go on to a nursing facility for rehabilitation, at a cost of about $22,000. Medicare pays for rehab only for people admitted to a hospital for three or more days as “inpatients.” Medicare will not pay for rehab if they were classified as “observation status” when they received treatment at the hospital.
Kelley-Nelum did what advocates advise anyone on Medicare to do. She found out how her husband was classified and asked if he might need rehab later. Then she spoke up -- loudly. She asked so many questions, she said, the doctors grew tired and sent in someone from hospital administration. That person relented and changed Doc Nelum's status to “inpatient.” His entire $22,000 bill was ultimately covered by Medicare.

Kelley-Nelum says her husband was lucky she was there.
“If I had not been there my husband probably would have accepted the observation status ... on face value.”

Source:
How to Avoid the Two Words That Cost Thousands in Medicare Bills

13 comments:

  1. critical information that can cost you dearly i saw this in the news a couple years ago giving me the needed information when a relative was hospitalized i was able to have the right questions to ask in patient or under observation the nurse looked at me with a look that said well now how did you know to ask about that sneaky trick relative was admitted yes thats good news so i asked for a copy of the record that proves it do not leave the facility without proof the hospitals might or might not offer this information best to get this out there asap this trick is used so the hospitals readmission rate is low aha see there are reasons so the hospital can get good grades and reviews for low readmission numbers more dirty tricks by administrators while the ground troops the medical teams are doing their best for your quality of care while management is out to put themselves first

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  2. thanks nasga, I appreciate this info

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  3. What I wonder is why the hospitals do this? I know it's in their best interest, of course, but how? Medicare is going to pay for these hospital stays so why not just bill Medicare?

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  4. Brenda, you make us all so proud. This is important information and everyone needs to be on the lookout!

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  5. What an honor, Brenda. And you deserve it. I know you work so hard to advocate for the elderly and I'm glad to see you get some recognition!

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  6. You have to be on your toes every minute of every day.....

    Thank you for posting NASGA.

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  7. Wow! Great information. I watch CBS News so wouldn't have seen this one. Thank you.

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  8. I will remember this for sure!

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  9. Thank you Brenda for coming forward and speaking about your experience about hospital management.

    Your account on the news will save countless people much misery and grief by knowing when and what to ask that could very well cost them their life savings and yes that includes their homes.

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  10. A standing ovation and a round of applause for our own Brenda Kelley-Nelum!

    We are pleased to know Brenda and have her valuable help as NASGA's Legislative Liaison.

    Brenda is knowledgeable in all areas involving the elderly, including "Under Observation."

    Thank you as well, NBC News, for choosing Brenda as our interview!

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  11. Brenda, you're a pro and an inspiration!

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